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By now we've discussed pandemic fatigue, languishing, anxiety, lack of services, suicide rates, social media, FOMO, triggers, fake news, school shootings, a former narcissistic, toxic, grandiose and insensitive leader (Trump), self-harm and trauma and more with our kids.   By now things should go back to normal.   Yet what is this new worry creeping into our consciousness?  I like to monitor new words I hear in therapy: intersectionality, amplify, conflate, weaponize, - fighting words. I'm also hearing this: "what's the point?" Or, the perennial, "how can I go to the best college?" These two extremes are not that far apart. One kid realizes she can check out and nobody will notice or care; another says the only way out is to torture herself with work and worry.  Neither is helpful or productive. Depression looks different in young adults in some ways.  So does mania.  Going to extremes and black and white thinking is a hallmark of the adolescent brain.  How do young adults find balance in a world increasingly in chaos?  How can I teach DBT or self-regulation when before my head hit the pillow I asked myself for the first time in my life, "what if there's nuclear war?"   We start with the breathe says my yoga teacher.  I guess the fulcrum of yoga and psychotherapy, or eastern thought and psychotherapy are a potentially liberating place from which to launch, when all else fails.  According to Mark Epstein,  “When we stop distancing ourselves from the pain in the world, our own or others’, we create the possibility of a new experience, one that often surprises because of how much joy, connection, or relief it yields. Destruction may continue, but humanity shines through.”― Mark Epstein,  The Trauma of Everyday Life If I had a dollar for every time I asked a teen to stop avoiding and start living...  fear cannot help you treat anxiety.  Only exposure can.  If we face the thing we fear, and we don't get struck by a lightning bolt, we can continue on our journey.  The only way around is through.  Or as Pema Chodron said,  “The only reason we don't open our hearts and minds to other people is that they trigger confusion in us that we don't feel brave enough or sane enough to deal with. To the degree that we look clearly and compassionately at ourselves, we feel confident and fearless about looking into someone else's eyes. ”― Pema Chodron Lisa DaMour, one of my favorite authors on teens and therapy, has discussed the enormous pressure on this generation in her book "Under Pressure."  One of the things she emphasizes is that we have to teach kids to TOLERATE discomfort, “Unfortunately, anxiety, like stress, has gotten a bad rap. Somewhere along the line we got the idea that emotional discomfort is always a bad thing.”― Lisa Damour,  Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls Try telling that to a 16 year old who just had a break-up and refuses to go to school.  Or the almost 17 year old that her parents' divorce is not going to cause her grief and upset as long as they conduct themselves with respect for the family.  When asked how her parents were behaving, one pre-teen told me, "They lead 'common lives.'"  I thought that was funny -- but yes, isn't that the goal?!  Some of these parents are acting like teenagers themselves as they frantically run from partner to partner and forget to make dinner.  All the kid wants is the car keys and the answer key.  To which the answer is usually a hard NO.  Or what if that teen's behavior suddenly becomes erratic to the point of misjudgment on everyone's part -- now that's when you might call the therapist.   But for all this to work, the precondition is openness .   When I rattle off 25 things the person can do to self-regulate and they do none of them during the week, what do you think changes?  Nothing.  Because they didn't change anything!  Resistance, anger, judgment and shame are all barriers to care.  Take a step back and slow down the therapy.  Make time to breathe and be still.  Then maybe you'll have a fighting chance at change.  But with no effort or over-effort, the body tenses; the work gets stuck; the future is frozen.  As the great Irvin Yalom said, “Despair is the price one pays for self-awareness. Look deeply into life, and you'll always find despair.”― Irvin D. Yalom,  When Nietzsche Wept   Despair is not the end -- it's the beginning of being seen, heard, understood.  Let's allow it some space.  Get ready.  Go.

Once I was waiting in a crowded city waiting room, in the paralyzing dread of my upcoming amniocentesis.  These were the days before trigger warnings.  I just sat there waiting, knowing there was a modest risk ahead and weighing how long it had taken me to conceive. Then the receptionist shouted across the room: Mary Jo Tucker, your sonogram was positive for xyz...  Every woman sat up.  The woman was about to get tragic news and now the whole waiting room knew it.  I once said to a doctor how about I start a support group in the waiting room, for all those infertility people struggling with bad news?   My other pet-peeve is honey/sweetie/dear when you don't even know me or why I'm there.  If I lost ten pounds, you could call me sweetie.  Then: you put me in a windowless room, shut the door, make me wear a too small inside/out gown and freeze while hours go by.  Or the endless hedging, like when my mother was dying, and the doctor said, "Everything's gonna be alright." It wasn't.  Or when my husband almost died after surgery and I had to run through the hospital to gather his team of doctors myself.  Another time the nurse left and just shook her head while looking at the screen.   Are they doing this just to women?  "Calm down and you'll get pregnant 1,2,3."  Or I feel pain, bloat and headaches, weak, tired, anxious.  OK you're likely drug-seeking, or you're lazy or just plain stupid.  How many times have you been dismissed for something very real indeed.  (A year later, it all pointed to thyroid). Some doctors will prescribe an antidepressant, others not.  So you're down to a toss-up. Get immediate help from a trained, caring professional, or move to the back of the fragmented line. There's no one-stop shopping in medicine.  Urgent care might have been a fine idea before.  Then it lost its allure.  Long lines and randomized chaos during Covid took over that venture.   Nurses of course are a whole different breed.  Some of the best people I've ever met in my life are nurses.  People who are literally the salt of the earth.  They have helped me, my family and my clients in countless small and big ways.  But in the pandemic they suffered terrible loss/sadness/grief/burnout.  Where are they now?  For mental health nurses can be life savers.  Not to discredit some fine, outstanding doctors.  But could we re-think the benefits and compensations for people who do this work day in and day out? More incentives to come out of college debt free for nurses and social workers so we can do the work we were called to do without the crushing burden of loans? Doctors are leaving by the droves.  According to JAMA , one in five are leaving their practices. Covid burnout is cited as the number one reason.  They said,  "Another national health care worker survey, the Coping With COVID study, found that burnout approached 50% in 2020 among 9266 physicians across medical disciplines. Last year’s survey results, which haven’t been published yet, are more dire still, according to study coauthor Mark Linzer, MD, a professor of medicine at the University of Minnesota whose research focuses on burnout. His takeaway: burnout has increased considerably as the pandemic has dragged on." Our culture is shifting in any number of ways away from care toward robotic scenes from dystopian movies.  Greed and violence and guns and teen suicide are looming: history repeats.  Why don't we do something of substance.  Now.

A Memoir in 5 Parts LOSS: I was born in New York, New York. NYC. The Big Apple. Nothing too dramatic happened. I attended Rivervale, NJ Elementary School until first grade. I was a likable kid. I lived on a cul-de-sac called 603 Dale Court and paraded in the rain with my neighbor Mary-Beth, singing Christmas Carols haplessly along. The next home was Scarsdale, NY. Nothing was wrong there either, but there was a succession of failed dogs. When my parents started having problems I was busy with my cousins and my friends, skiing, going to Florida once, not really noticing that my friends were all wildly enriched. Nevertheless I was popular, even with braces and glasses, because I was a people pleaser, athletic, musical too (I could carry a tune!) and smart enough. Not top-of-the-class smart but with reasonable effort, could hang around the top quarter.   In the days before phones we lived idyllic lives. Every one of my classmates remembers playing after school and coming home for dinner when dusk covered us.  I didn’t know that my father was a bi-polar narcissist either.  And for as long as I didn’t know it, I was happy.  Whether restricting food for a minute or a little anxious or sad, it had little impact. Everywhere I turned being tall and athletic buoyed me. My father and his father were known for their wit [Grandpa Sy was some kind of bridge master]. I enjoyed their easy banter and clever expressions, like one of the guys, throwing a football and learning different plays by the time I was 10.  We went to Knicks and Giants games often.  My dad being in the book business was a strange thing - no one quite understood it.  It meant that for my friends’ bat mitzvahs I embarrassingly had to give them glossy storybooks that now would be considered like fine art (we were afraid it was weird).  At camp I won an award: All Around Camper.  40 years later my own daughter would win “Best All Around Kid” at her HS, one of the proudest moments of my life, which also includes my oldest getting into an Ivy League school. FEAR: At college I reflected on my parents’ divorce from 1976 when I was a mere 15. My sister says, “You never got over it.”  That made me defensive.  As a therapist shouldn’t I at least have gotten over it?  I think I finally understand that there is no getting over it, as the loss of the most important person in my life was a trauma.  I fell into the trap so many of us do: thinking I could ruminate my way out of it. Turns out that doesn't work. That was another thing I never realized or named, so clueless was I to my own grief.  I continued to do well in college, even meeting Bernard Malamud the incredible Jewish novelist, and Bill (William) Kennedy, a uniquely talented writer of the “Albany” books.  Later I met John Glenn, the astronaut and Bessel van der Kolk, the leading expert on Trauma. GROWTH: Graduating early meant leaving my boyfriend which was a big fat mistake.  One of several I would make in the following decade.  I never had a mental breakdown, but I sure did self-destruct, picking the wrong guys at every turn.  Having “daddy issues” was fine while it lasted because I was skillful in replacing him; but it soon turned into more pain and loss.  My 20s were just a cycle of relationships, all doomed from the start, because fear of abandonment jinxed my insecure attachments.   I met my husband at 29 and was married by 30.  He was and is the very eccentric love of my life, but never easy breezy.  One didn’t have to look much farther than his immediate family to see strain, conflict and regret -- even coldness and selfishness.  When my sister in law left her husband, my husband’s brother, after 30 plus years of marriage, she railed against the pathology of the family, not realizing that I had discovered all that decades ago.  Still I held on.  One thing this family did produce was fine, intelligent and gorgeous kids.  As sperm donors they were unmatched. GRASPING: My 30s brought hard work and much frustration.  His career never seemed to gain traction.  There was an up/down rhythm to it that was all too familiar with my father, who while a rising star in his industry, made deals based on hubris not rubrix.  Creative people never get business right I’ve heard.  But my father peaked and then never figured out what to do as the print went digital and he was left behind.  In an industry of young women editors from Bryn Mawr and the like, he swooped in with his charm on steroids, like Willy Loman himself, selling those manuscripts, knocking down doors, succeeding but then not, always waiting for the next BIG THING.  He trained us on how to arrange books in Barnes and Nobles and Borders so the jacket would face out on “his” books.  I grew to devour books - how could I not?! (Boxes of Bantam's bestseller list books arrived at our doorstop at least once a week).  But then he was gone, and the four times a year visits to LA grew tiresome, even scary, as his behavior was erratic and unpredictable.  Not often but sometimes he would rage or have a creative streak, or a low around holidays with nothing to do.   HOPE: After infertility treatment I gave birth to two spectacular girls, the gifts of my life, and I sacrificed everything for them when my husband could barely work following failed back surgery.  Yes I resented it but I saw them thrive in the last 20 years.  Both went through school relatively unscathed and both are successful in many ways academically, socially and emotionally.  I know that my work is hard and I’m supposed to take breaks. As I near the age my dear, beautiful mother was when she died of ovarian cancer, I think if I died now, I did a really incredible thing. I used my ability to learn, care and be spiritually open to not only help others, but raise my kids to be strong, resilient leaders.  I wish I could travel more, but otherwise have few regrets.  I wish I remembered more about their childhoods -- it went so fast.

PHOTO CREDIT @Rosalind Banks; Art By Rosalind @Facebook Previously published: https://centerforhealthjournalism.org/2022/06/12/college-students-are-struggling-are-schools-doing-enough-help      I just returned from a law school graduation at the shockingly beautiful Cornell campus. Once known as a pressure cooker, where six students committed suicide in the 2009-2010 academic year, Cornell looks like it is working to prevent more tragedy. Bright, inviting signs for mental health help and non-judgmental support are pasted on bathroom stalls and along the walkways. As COVID turns the world into a place of greater loss and fear, colleges are facing a mental health crisis. In a February 2021 survey by the American Council on Education, 73% of college presidents identified student mental health as a pressing issue on campus — in many cases, the most pressing issue. Presidents of two-year and public four-year colleges were more likely than their private-school counterparts to voice strong concerns about the psychological and emotional wellbeing of students.  Troubling as the data is, it comes as no surprise to mental health experts familiar with campus life today.  “Students are arriving to college campuses with increasingly complex mental health, substance use, financial, and other challenges which may interfere with their academic success and quality of life,” said Dr. Doris Cimini, a psychologist and director of the Center for Behavioral Health Promotion and Applied Research at the State University of New York at Albany School of Education.  It’s also not surprising to therapists like me who treat teens and young adults in private practice, or to parents like me who have kids in college or recent graduates. With nearly 20 million young people attending colleges and universities nationwide, these institutions are “important potential ‘safety nets’ to protect young adult mental health,” according a 2021 report  by the National Academy of Medicine. Like Cornell, many schools are trying. But efforts are inconsistent.  One of my children went to a public college that had “wellness” as the theme of the dorms. My other child attended a private Ivy that capped free therapy at five sessions. After that, students were on their own.   Aside from the alarming mental health trends and two years of disruptions due to COVID, the obvious strain is the inherent vulnerability of this age group. Campus mental health is a critical investment at an urgent time. It’s going to take more than adding a few therapists, or, for that matter, tacking up mental health posters, to provide the support that young people need. How we got here In the years leading up to the pandemic, college students were already showing inordinate stress.   One of my clients left school because of a break-up. Another wanted twice-weekly sessions because she had stopped doing her work or forgotten how to study altogether, and she would lose her scholarship if she dropped a single class. Another client told me she had a nightmare that her entire family was shot to death. Still another had a free dorm room for summer — but no food. And then there was the Georgetown law student who stepped into my office and asked me to stroke her hair to comfort her. I had never met her before!  When we left young people who were already under pressure alone in their rooms for two years, what did we think would happen? About 40% of Cornell students reported feeling dysfunctional for a week or more because of depression and anxiety, according to the  campus newspaper .  A one-to-one intervention can be expertly timed, but how do we take care of a whole cohort? It obviously doesn’t help that anxious and depressed students at many colleges now have longer wait times for help. On the blog of Higher Ed Today , Kate Wolfe-Lyga and Marcus Hotaling outline important policy solutions. These include training all faculty and staff to become suicide-prevention gatekeepers, developing agreements with community-based agencies to supplement services provided by campus counseling centers, creating a guide that directs students to supportive resources, and including a crisis contact on student ID cards. These last two ideas are so straightforward, it’s hard to believe they’re not standard.  But one of my clients called me, crying, because she couldn’t even find the campus counseling center. (“Look on a map!” I said. But she was too upset.) Best practices What some colleges do well is free, brief therapy. Much can be accomplished in 10 sessions, especially if mental health professionals are trained in short-term therapy.  The structure is good for teens and young adults, and it gets them back on track.  But after those sessions, students often are left to fend for themselves. Finding therapy and psychiatry is difficult at best. And it’s often impossible for students facing financial or social barriers: young people who are undocumented, LGBTQ, food insecure or underinsured. Peer-to-peer mentorship programs and 24-hour student-run crisis hotlines, such as the model at SUNY Albany, are measurable winners. Wellness workshops can serve as a balm and give students a sense of belonging that has been all too elusive these past few years. Faculty can model self-care and wellbeing and encourage similar behaviors among students, for example, by taking lunch away from the phone and computer. Schools should also facilitate connections with professors, advisors and others who can offer support. Drop-in services are crucial. Making a serious investment in college mental health comes down to prevention, wellness, accessibility, relevant programming and community outreach. In a recent New York Times essay, Jonathan Malesic, who teaches at Southern Methodist University, reminds us of a tenet of social work: “Meet them where they are.”  My clients are beset with fears of failure, loneliness, debt, war, guns, climate change and health. By meeting them where they are, these topics and fears are put out in the open, destigmatized and given meaning.   At the end of my young adult support group on Zoom every month we show our pets, because it’s that important. A beloved dog, cat or bird can reduce your blood pressure, not to mention alleviate loneliness and boredom and provide comfort. I write letters for emotional support animals all the time. Although my generation had struggles growing up too, we did not lose two years of our lives to utter dread and a flatline of boredom and social isolation. But our systems of delivery are slow. More money, time, attention and openness can create the space for more therapists to meet the skyrocketing demand. Where is government leadership on such things?  At Cornell Law School graduation, the sun was shining and the students seemed hopeful. Their speaker said, “Don’t be afraid to ask the hard questions.”

I dreaded the first face-to-face family therapy session since covid. I had pimples on my chin from masking and I didn't care to put on make-up, barely doing that in the before times. I had studied family therapy exhaustively in my 20s, fruitlessly trying to figure something out about my own family that never materialized. Therapist heal thyself.  Now I faced the angry 15 year old girl with the goth look and a small, knowing smile.  No screen between us.  No buffer.  I decided I would show her I was HER therapist even as her family pushed back. There was a dialectic in this family's presentation. The parents were in denial about how severe their daughter's self doubt appeared. I had nailed it quickly, because I read and reread her discharge papers late into the night. It involved a meltdown on the first day of camp. They chalked it up to teen angst. They said their hometown was too stressful and they would move 500 miles away to change it up. Tomorrow .  Telling the kids with me there was a manipulation.  I had to stay on my toes.  We do not do the heavy lifting for our clients.  We simply help them navigate.  My skills turned to process: how do you feel? What do you feel and when do you feel it?  Again the daughter registered the fear for the whole family by biting her lips and scowling.  The mother seemed cold; said she didn't like therapy. I instantly disliked her and saw her daughter's black eye make-up and wondered why she was so dark and stormy.  I saw the mother's constricted thinking on her face when she declared, "I had bad therapy in the past," and looked away, not toward, her child.  Sensing dark secrets I waited for them to make their agenda clearer, but gently guided them back and back to their daughter who defiantly stated: " I can't do things," while her sister smirked. Attractive all. The parents naively thinking their child was in a stage. But the fixedness of her all-or-nothing was exhausting me. Is there no possibility that things could improve because you're moving to the country on a whim? How? Why? The father was bonded w me as soon as he proclaimed he had read "The Family Crucible," a primer on family therapy.  He was on my team.  The rest of them not so much. What do you want from your new life I said to the identified patient. How do you see yourself. How can we help you. I just want space, she said. This had been going on for years. The child didn't have anxiety, I thought, well yes agoraphobia - but it was the depression that left her stuck as if frozen in some 4th grade irrevocable choice that ended in bullying. There needs to be a bridge between mother and daughter.  How did I know? Doesn't matter.  What I knew was to ask about the process. How do you feel now, talking it out?  Could you ask your mom for what you need from her? And here began the real work. Tears. At the end we sat in silence. Good effort I said. And then I turned to the fragile, depressed girl, "I look forward to being your therapist." **Addendum: a week later I got my dear John letter. Thank you for your help as we move forward - in the new area we will be seeking in person therapy... Best of luck I say and invite the next family in...  ***There was no further communication between myself and her future therapist or family therapist or psychiatrist.

Something is off and it's not just "languishing." My clients are tired, fatigued, burnt-out and incredibly lonely.  You wouldn't think it's so bad in the Big Apple but isolation lies in plain sight.  Stuck, confused and cynical about the future are the precursors to more serious immobility.   I keep asking myself, where is the middle path?   If a client is terrified to go out, and she instead stays in to the point of not eating or sleeping or changing clothes, suddenly a cascade of failures come before her.  And she's only 25!  She loves her family, but it's time to get out already!  So what she grew up under the shadow of an alcoholic parent.  She has a little potential to spare but nowhere to go. In the Big Apple you're either in-sync or you're not.  There are not too many slices of the pie without grabbing.  If you're catatonic, we have some great city-run hospitals that evaluate you, medicate you and then spit you back out.  If you're energetic, you can fly until you crash.  Life is a series of ups and downs.  Look into your Vagus Nerve.  Then roll the dice and see which i-Ching is yours.  Because my friends, luck is mostly all we have; and a sliver of chocolate.   My clients don't want to go to the hospital.  They know what it is to get a bill for $250K because your insurance messed up again.  I know too.   So what I think we need is bring back the halfway house.  Have a sanctuary for people to reclaim their worth and dignity. Have a haven for teens who can't sleep at home or need a hot meal.  Drop-in places that are warm and non-judgmental.  I'd love to be able to say, hey Susy, I know you're suffering and in pain.  It will pass.  However in the meanwhile I know a place for you to rest.  They will get you whatever you need, like some American Jews did when millions of their cousins were getting vaporized in Europe.  They got them papers and blankets and sponsors and furniture.  Where is our humanity these days?  Why are Putin and Trump at war with unsuspecting innocents?  Don't let yourself lean into authoritarianism.  We need each other more now than ever. We need resources to engage therapists in the middle path.  So we can take a day off and not lose benefits, so we can fix what we didn't break, so we can lend a hand, a meal, a ride, or a daily practice to our clients; so if it's evidence-based it doesn't have to cost an arm and a leg.  Free safe-havens for marginalized people to think, pray, love or heal. Someone to take you to your booster shot.  So young adults need not live in fear of failure.   Oh blame the Internet they say.  Blame social media.   Those are the symptoms not the causes.  We need more big picture people.  Those with a vision to treat patients in their homes, to bolster communities, connection and so forth. My community does this so well.  Every single day there is something for old and young.  But so many people I deal with do not have a middle path.  They have riches and hospitals, or nothing and no one.  Intensive Outpatient Programs have to expand with a single payer. Enough of holding people hostage to their jobs for health insurance.  Real freedom for students to study in peace without the dread of a bill from the ER.   My friends from Sweden are not troubled by these matters.  Imagine the actual joy for our future leaders if they didn't drown in debt, loans, taxes and taking care of the elderly.  The cost of childcare.  We are hostages to capitalism now.  Just a step away from robots.

Photo Credit @madgescottstudio       I get no respect, said Jackie Mason the comedian.  That's how I feel.  Oh mom's in the basement working with clients. What an easy gig!!  Just chat with people on the phone or zoom or in person, like a friend!  Well that's your first mistake.  A friend told me she wanted to become a psychotherapist - how hard is that?  Hang a shingle!  A lot of people seem to do it...  Let me be the first to tell you, it's not easy. So if you're looking for easy, you can stop here. As I type this I'm juggling more than 40 people on my caseload, their LIVES in the balance.  Just let that sink in.   I used to work at iVillage, a startup for women in the heyday of the Internet boom around 1999-2001.  Now that was easy . They would call me in the middle of the night to fix a typo!  Now I get calls on Yom Kippur; people wanting to throw themselves into a pond. People are suffering - no doubt about that.  To become a Licensed Clinical Social Worker you have to put in YEARS of training and practice and continuing education, all at your own expense, and then you can get paid less than a secretary to manage it, with no benefits.  Until the pandemic we were literally the lowest (wo)men on the totem pole of meaningful jobs that you're supposed to be thrilled just to do.  In those years of school and work, you must be client-facing for thousands of hours, under direct supervision.  You must study not only psychopathology, but practice issues, community issues and global and ethical issues.  You must write papers, a thesis, that asks you to engage in not only measurable and evidence-based research but also keep the balls in the air, control your personal transference and dig deep inside for insight into your own reactions. No problem!  Again, if you still want to become a therapist, keep reading. I love what I do and I'm called to it.  However, I do not wish to do it all day and night.   A typical intake session gathers and identifies relevant background information and present-day stressors and supports. People ask, if I had a prior therapist, how can I start all over?  In my opinion your story will emerge regardless of how much or little you tell me. I will ascertain the patterns in whatever you choose to start with.  Then comes the meat and potatoes - why do you feel the way you do, and what can we do about it?  Benefits of medicines and therapies can offer a reasonably quick recovery for some.  Harder problems require longer, slower efforts.   Some people ask - please give me a diagnosis, I need a diagnosis.  Why?  Why do you? Am I BPD they ask, without even knowing what that means?  Or ADHD?  Or Bi-polar? Thirty years ago that wasn't important to me at all.  I thought I knew better.  Then I finally noticed there are indeed symptoms that match up quite well - this could be helpful.  Now I'm back to not caring - diagnosis is too reductionist. Holistic is my path now.  OCD is not the same as cleaning the kitchen.  And a mood disorder is not the same as having a bad mood.  People get caught up without examining the distinctions.  And yes, if you drink too much coffee you will feel more anxious. In one session I hear a lot of self-blame, guilt, and loss of time and dates of things. That tells me we might be dealing with PTSD.  In the next session I hear a lot of black and white, all or nothing thinking, a typical hallmark of young adults.  That tells me to introduce CBT, where we modify the thinker's thoughts, make them more equanimous,  (In the Buddhist tradition, the term “equanimity” ( upeksha in Sanskrit , upekkha in Pali) is a complex construct that has been given multiple definitions along the development of Buddhist thought. At its heart is the word for 'eye' and 'see', with a prefix suggesting 'gazing upon' or observing without interference).  I explain the concepts as I go.  This could make the recipient think that I don't have an agenda, or I'm not writing things down? But rest assured I do! One of the things I do best is an initial assessment.  I'm good at it because for YEARS I've been practicing and studying the difference between normal teen behavior and alarming teen behavior.  I guess you could even say I'm an expert at the age of 60 yrs. In the next session I hear and see a lot of tension, stress and loss.  I'm thinking sleeplessness, self-care and grief.  Anxiety. Failure to launch.  Languishing, isolation and fear.  This is the pandemic now talking.  Did you have this before?  What were the antecedents, even though there may NOT be a one-to-one correlate to what happened before.  So keeping an even cadence, co-regulating with my client, whist my dog is barking and the doorbell is ringing and kids are arriving home from after-school activities, no matter, I am with my client, in the present moment, making judgment calls.  I realize I need to introduce DBT in the next session.  I record a process note, do the billing, get a glass of water and lean into the next appointment.  This repeats about 10 times a day. Then a patient wants paperwork for FMLA because her dog died.  I do it without charging for my time.   Did I forget anything?  Oh yeah.  I have to check in with the parents, write and email, and organize my schedule.  By the time it's 8pm I'm toast.  Since Game of Thrones ended I have no escape.  The days drone on.  I love my work but I have no benefits.  No work, no pay.  Too much work, too bad.  No health insurance - so be it. We say we're in a mental health crisis.  No one can seem to find an affordable psychiatrist.  I have to go to my yoga class now.  The system cannot hold. Oh, and I need to order a workbook on PTSD for my next patient, while I practice my own EFT (tapping) technique.  The weekend arrives and I am completely shot.  I wonder why?

I just got back from my 40+2 years High School reunion.  It was the ultimate connection and we all agreed we were so very fortunate to have shared a relatively innocent, prosperous and peaceful time in our early lives together.  There's a bond there that is uncanny - the person gets you at your core.  There is no language needed.  They knew you at the essence of you-ness.  It's like the missing tree or something.   Some of us had divorced parents, but very few growing up in the 70's.  I was one of them and it has haunted me for much of my life.  I often felt "less than" even though I appeared to have it all.  Of course none of that really matters anymore.  We have grown old now - empty-nesters mostly.  Everyone has faced down hardships by this point in their lives. One close classmate was missing, battling cancer.  Several have died.  I recently lost my 2nd parent.   It's not news that divorce is the gift that just keeps giving.  I have worked with this for all of my career.  Many will say, well the kids are older, so it's OK. Probably not.  Even young adults have feelings!!  I often hear them in therapy saying: major conflicts continue. And that, it turns out from the research, is the clincher.  Unlike losing a parent, you simply keep them and their problems for the rest of your life; IT NEVER ENDS!!!  Therefore, the work in therapy does not have a time limit. Just because you're "emancipated" at 18 or 21 does not mean you're free from childhood trauma, not even close.  That's just the beginning of often lifelong insecurity, worry, self-doubt, shame, worthlessness, confusion and more. Who will walk me down the aisle being just one of many. -It's important to go back to the time of the divorce with young adults , not to re-hash or re-traumatize but to understand just exactly what has changed in you, and the magnitude of that loss. -It's important to look at how you were "parentalized" while they were acting out - meaning did you have to take care of adult things as a child?  How did that work out? -It's important to acknowledge that it's on-going.  Every single decision and holiday is more fraught than before. -It's important to understand that you can't figure it out.  I tried for years a kind of mental trap: if I can just be smart enough to dissect what happened I would have some relief.  Not so much. -It's important to realize not only is it not your fault, but you weren't defective; they were. They owed you some stability.  It was their job.  Divorced parents seem to become wildly self-absorbed in the aftermath - making up for lost time.  Or, they go the other way and start hoovering you into their over-involvement.  Either way is an unnecessary extreme. As a young adult it's your job to individuate - separate from your parents.  How can you when they are failing social-emotionally?  If you're swimming and you need to turn, and there's no wall there to push off of, how can you accelerate? I know not every divorce is a disaster like my family's was. But it still hurts bad at ANY age.  There is no right age. So don't let anyone tell you, oh move on already.  Go back to your High School self and thank yourself for doing the best you could, before you knew what to do.  Everyone has a struggle, and the struggle is real.

What is going on here? People are still: tired, cold, burnt-out, lonely, stressed, bored, stuck and unmotivated.  Kids.  Especially teens.  But they're back at school.  Why OH Why is this holiday season turning out to be like many others - damp, lackluster and downright dreadful.  It's not the weather. CEOs made 399% more than workers in the past few years.  Think about that.  So the rest of us are just working, shopping, spending, staying home, skipping much needed vacations, getting COVID and crying ourselves to sleep.  What is wrong with this picture?  What is wrong with America?  Young people are committing suicide in record numbers. 3,000 lost their lives to gun violence, while other watched in panic, suffering long after the violence washes over them.  Then look at the TV.  Guns, guns, guns.  Then tWitch/Boss shoots himself in the head at the age of 40 leaving 3 stunning children fatherless.  WHY??? I guess if I knew the answer I would know the answer.  I don't.  I worry about a person last week that my team rescued from throwing himself in front of the subway.  I worry about the girl going up on her meds and getting activated.  I worry about the guy who mixes every substance and expects to wake up and go to work the next day un-phased.  I worry about the teenager whose parents don't believe in medication even though she's had depression symptoms for over one year.  I worry for the losses stacking up on kids too young.  What will this mean for future generations?   I am parent-less now.  It's sometimes exuberant not to have to check in or check out.  But my assumptions from childhood were so naive.  That people would stick around.  That people would have my back.  That I would know love and security; adventure and risk.  Not meant to be.  I sacrificed for my family and I asked for little in return.  Two summers ago I found an Airbnb cabin in upstate New York to visit.  You could walk out to tiny pond/lake and swim around it, come back, hang out, and then go back in again.  That was my sanctuary.  I went three times during the pandemic.  The only problem was a boom-boom explosive noise in the distance that the dog made clear was not for him.  Otherwise, a perfect idyll.  A time to do nothing.   All we can do is carry on.  Let the memories of your people near and far and gone carry you through all your days with the light of Hanukkah.  May the glowing candles remind you of your grandmother Rose, who cherished you.  Who created you.  Who lives in you.

If you're hard on yourself like I am, why not make the new year about change and growth?  It's not about eating less, or stopping your OCD habits, or starting an exercise workout, or playing pickleball, although these activities help enormously. It's about doing you in a way that feels more calm, dependable and meaningful.  Self-care is not a bad word.  It's not lying on the couch in a coma.  It's not getting a manicure.  Although these things help as well.  It's about integrating the good with the bad, practicing wisdom and equanimity, generosity, patience, and care, with yourself first, then with others.  It's about showing up for yourself and giving things time.  It's about slowing down, yes, in our fast-paced world.  Is it about putting down your phone?  Sure.  But if you're like me, and need to read the big print version on your phone, then read. Or reaching out to a high school friend with whom you've re-connected, then keep the phone.  Social media, I have said from early on, is not the enemy.  The enemy is within.   My friends, the biggest change I have made is letting things go.  Things I cannot change or control.  In my mind and body together in harmony.  In stopping running around just to run around, and in starting meditating.  Meditation in daily life. Routines and structure, meaning and work, risks and rewards.  Body positive.  Outdoor therapy.  Online groups.  These are the The Body Keeps the Score activities that create space.  The space in your thoughts that lets you know that pausing is beneficial because it gives you a moment of objectivity.  Young adults that I work with lean on black and white thinking because their brains are in rapid acceleration.  Their amygdala (the regulator) and the synapses (the communicator) are firing in spite of them being still so young and vulnerable, and it's confusing.  Parents often mistake this avalanche of emotion as negative, but this is supposed to happen.  What's not supposed to happen is sitting in your room for two years contemplating who liked your photo.  It couldn't have been prevented, this pandemic.  It robbed us of time, money and people.  It took and took and we felt taken.   But we (a)rise, as the powerful Maya Angelou stated. Here we are in mid-town Manhattan.  Here we are with friends.  Here I am with more clients in a row, on wait lists, and I'm 6-0!!!  Who could believe that a social worker supporting her family could thrive at this time?  Doors somehow open if you venture toward, lean in and listen, look for that Blue Heron on the lake.  Don't let it fool you into a photo bomb; rather, take it easy and wait for your moment.  Hold the breath for a second longer and see: you can tolerate loss because it's what's happening.  It's the only thing that is happening.  People seem to fade away, but all new people are coming, and you, yes you, can change the world in an instant. My clients are doing well.  They really are making progress.  Why?  Because they are accepting and owning their lives.  It's yours to hold.  We are watching "The Affair," a wonderful series that experiments with point-of-view.  The theme song says, the only thing to do in this life/ is be the wave that you are/ and then sink back into the ocean. (Fiona Apple)"  At first we thought it said "be the way that you are" which sounded so wrong.  Upon further investigation, the song really hits it out of the park with its staccato rhythm, and force toward inevitability.  Death is not dramatic, in my experience.  It is lonely and quiet.  An absence of a life force so incredible that it returns to dust.  I believe in ashes to ashes, dust to dust.  Not some fancy up-above that is just a fairy tale.  The earth is good; it grounds us.  Be the good earth.

INTRO: Courtney was the kind of 10th grade client that I completely enjoyed.  She was cute, clever and motivated. So when she began to have an issue that ballooned into a crisis, I was a bit surprised. Her parents found out that she had shared a nude picture with a boy she knew, and he then proceeded to share it with the whole school. The following week, Courtney landed in the hospital from sheer humiliation. Thankfully, Courtney was able to get immediate help and went on to lead a productive life -- forever scarred by her simple mistake, blamed and mortified for what another kid didn’t yet understand about privacy. It is so convenient for friends, family, therapists, teachers and parents to say, social media be damned, especially after an episode like Courtney’s. I agree with what they’re saying, after all, it’s legitimate to protect your children from porn, abuse, catfishing, danger and predators. My biggest parenting regret is not removing the phones from their hands at 10p, like many parents do. Sleep is the number one predictor of functioning in my book and too many kids simply cannot resist the allure of talking to their friends all night. I worked for early internet start-ups in the health and wellness space for some time, so I cannot readily cast away its benefits. Imagine you had breast cancer in 1998 and wanted to meet others going through the same thing - we invented that! At iVillage.com we developed online support forums for millions of cancer patients! There was no one we couldn’t reach, solving the problem of mental health access for the first time. For me and thousands of others the internet provided research, group support, organizational capabilities like syncing calendars, and so much more - a meetup with my best friend from 4th grade, for example. ( https://www.nbc26.com/news/local-news/the-complex-relationship-between-social-media-and-mental-health#:~:text=Social%20media%20can%20be%20a%20virtual%20window%20into%20people%27s%20lives,cause%20more%20harm%20than%20good ) MIDDLE SCHOOL: We know the stats on texting (teen girls - 80 texts per day! - https://www.pewresearch.org/fact-tank/2010/04/28/teen-girls-text-more-than-boys/ ) - and girls do it far more than boys.  Is texting bad?  Not really if it’s used for, “honey I forgot the milk, be home in 10.”  But my middle school clients, always girls, spend entire sessions reading their text exchanges to me.  According to Lisa Damour, my favorite author on this subject, “Texting is a very powerful way to have conversations with boys, and there’s no shame in that,” says Dr. Damour. “As long as kids are talking about their feelings, it doesn’t matter to me how it’s happening,” --( https://grownandflown.com/lisa-damour-get-teen-boys-open-up-deep-conversation/#:~:text=%E2%80%9CTexting%20is%20a%20very%20powerful,Damour%20says .) Middle schoolers are trying to learn how to communicate, and patients like Courtney typically do a damn good job of it. It enables them to clarify their own voice, sometimes pause (leave “unread”), and then work through relational drama without the terror of having to say it face to face. It seems like a skill worth having. In therapy with teens, it turns out, we need to help them navigate, not shut down. HIGH SCHOOL: In high school, girls get busy with activities, sports and grades. The competition where I live (near NYC) is fierce. Knowingly or not, they vie for hierarchy among peers that can stretch from just being a bad-ass to being the smartest or dumbest or prettiest in the class. Much of their doom scrolling leads to listlessness, boredom and shorter attention spans. But it also helps them learn fact from fiction and gain judgment: view a painting for an art class, or see a citation from a real judge on the supreme court, or watch a science experiment from their living rooms. Looking at others’ luxury vacations creates “FOMO” and yet the phone can also be a godsend to organize and color code your schedule for a kid with dyslexia, for example. Some kids use it to set alarms for their meds and their mindfulness. One kid from my town created a travel app that made him enough money to go to MIT. Another client uses the phone to check her blood sugar and her diet for type I diabetes. Still another is using an app designed for CBT-i (cognitive behavioral therapy for insomnia).  COLLEGE: As for beyond high school, I had a client, Darien, who couldn’t write an email after graduating from an ivy league school, that’s how paralyzed she was. Now she works at a law firm. Learning to live with our technology might be a good idea. Apps that show me my daily usage are a bit scary - in the service of “I’m working” I have literally lost hours of my life, and my vision. (I actually need special glasses to help focus). Addiction is real and video gaming can really suck your soul, especially if it’s done all night.  Which social media ( https://seopressor.com/social-media-marketing/types-of-social-media/ ) is all bad? Facebook has fake ads. But they have controls. Instagram and TikToc have provocative videos, they too have controls. Snapchat is short acting, like a teen taking one drink at a party. It’s not good, but it won’t last. What about Twitter, the adult version of a bad playdate. But teens can also learn whom to trust. What is the difference between a reputable news outlet and a screeching rant by an excommunicated politician? Let’s find out. One day, they might even make a career of it. POST COLLEGE: What about dating sites for young adult clients? How does that cause harm? Ghosting has never been so easy. Do you delete it and stop trying? Sure you could meet someone at the local bar, or through a friend of a friend. Enter Covid-19, and dependency on alcohol, suddenly Hinge doesn't sound so bad. What’s wrong with LinkedIn? I get notifications from them every day for my dream job. Yet how many people really did land their dream job this way? Linking to everyone I have ever worked with helps me out. It helps me remember what my value is when I’m too flummoxed to present myself.   As a therapist we must stay open to growth and potential. We are taught not to impose our beliefs. So if my patient is on social media all day and night what would be more appropriate - to scold her and instruct the parents to remove all screens, or perhaps teach her that rest is critical to development, as is exercise, diet, spirituality and creativity (eg. self care). One of my clients is doing an online masters program in a special kind of painting that she posts weekly on Instagram. Because she has a significant trauma history, her present situation doesn’t allow for her to visit museums or lectures or art studio classes. But she can paint and post and maybe one day sell those paintings online. What gives her hope is the freedom to expose her work to the world without having to leave her room. Or the client who is ill and lives in a rural setting - she can talk to her BFF (and me) without having to drive. These are the many ways a young, isolated person may reframe the online world as an adaptation to her struggles, rather than the enemy. No one is suggesting that you stalk your ex and go through his emails, or engage in illegal/aggressive or shameful bullying, or worse. What I say to my colleagues who work with young people is this - save your judgment and let’s figure out what the pitfalls and potential are in each situation, then help our clients to filter-in what is meaningful, useful and practical for their communities; and filter-out what doesn’t serve them.

How do you get unstuck from feeling like you're underwater?   In this world of mass home-grown gun violence that terrorizes our own children, whom clearly we value less than the need to have a gun (how does this even make sense?), and the gross news cycle that spits out one man's name over and over to sell stuff to you, how do we cope?  Addicted to your phone, where all the good people who know how to do things right are on vacation, how do we cope?  With the the pitiful state of war in many small and large countries, the climate dis-regulation and the bipolar weather, how do we cope?  Watching the violence on TV that mimics our own worst natures, how do we cope? Sounds like the four questions. My friends the answer is to engender hope.  To be creative.  To make community.  To work less.  No one has ever come to my office and said, "I'm here because I wish I had worked more."  Au contraire.  We are wired for attachment: to our parents and friends and lovers.  So how do you make your life meaningful in a sea of confusion? If you're an adolescent and you see the world around you going to pot - indeed imploding - how do you find the motivation to carry on?  My father wisely said everything is cyclical.  Wait it out.  Sit with it.  Be patient with yourself.  Be a container.  Be mindful.  But wait - why is nothing working?  Did you try to change anything?  I am trying to only do one thing at a time - because that's all you can do anyway.  What did you change today?  Walk the other way around the block next time.   If you've listened to the masters of Trauma: Peter Levine, Bessel van der Kolk (whom I got to meet in person), or Tara Brach, Gabor Mate, you will note that trauma lives in the body. You will soon realize that if our children are seeing mass shooters and bloody children, their classmates, our future, lying dead before them, and they begin to develop school anxiety, avoidance behaviors, sulky moods and post-pandemic stress, this is REAL.  It's not TV.  It's not 13 Reasons Why -- more like 13 Reasons Why Not.  Suicide is real.  No other civilized country in the world operates like this. Many well-tested interventions exist that can reduce gun violence.  It's not that shocking.  With no controls whatsoever on purchasing a deadly weapon which only purpose is to commit murder, what we are seeing is daily tragedy - what do you think that does to people, besides make them numb?  Last month the shooter was at a college near where my daughter is at college.  Which one will be next?  If we do nothing, nothing changes.  Remember this. Remember the mental health crisis of children in 2023 because in ten or 20 years you won't wonder why they can't manage - you'll know.  It was our collective inaction.